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Medical Provider Enrollment Coordinator
2 months ago
Job Summary:
The Provider Enrollment Specialist will be responsible for maintaining accurate and up-to-date records of participating and non-participating providers in the provider database. This includes mapping claims in the invalid provider queue, resolving provider-related issues, and executing the panel transfer process.
Key Responsibilities:
- Maintain provider records in the provider database, ensuring accuracy and completeness.
- Map claims in the invalid provider queue and resolve provider-related issues.
- Execute the panel transfer process, ensuring seamless transitions between providers.
- Complete projects assigned by the Supervisor, prioritizing tasks and meeting deadlines.
- Interact with internal and external clients on provider maintenance activities, providing exceptional customer service.
- Communicate notification of changes to appropriate providers, members, and departments within the contracted timeframe.
- Coordinate provider mailing for claims in the invalid provider queue, ensuring timely and accurate processing.
- Research and resolve returned checks and provider mail, maintaining a high level of attention to detail.
- Assist providers and internal customers by responding to and resolving requests and inquiries related to panel transfers, panel releases, and special needs PCP assignments.
- Complete department reports and logs as assigned, ensuring accuracy and timeliness.
- Ensure work is completed according to service level agreements, maintaining a high level of quality and efficiency.
- Attend required training on an annual basis, staying up-to-date with industry developments and best practices.
Requirements:
- Knowledge of different types of providers and claims process experience preferred.
- Customer service experience required, with a focus on providing exceptional service to internal and external clients.
- Proficiency in software systems, including Windows 2000, MS Office, and IMAX (external claims editing).
- Facets experience preferred, with knowledge of Word, Excel, and ACCESS a plus.
- 1-3 years of healthcare experience, with a minimum of 4 years of experience in claims and/or call center environments.
Education:
Associates Degree required, with a focus on healthcare or a related field.
